Jaime L Petrus, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

017196 Issued in ME

Practice address

22 Bramhall St
Pavilion 1203
Portland, ME 04102

Phone

(207) 662-4618

Fax

(207) 662-6254

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1891881447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 WALLACE AVE",
            "city": "SO PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-761-0650",
            "fax_number": "207-761-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "address_2": "PAVILION 1203",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04102",
            "telephone_number": "207-662-4618",
            "fax_number": "207-662-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUS",
        "first_name": "JAIME",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "017196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30206869",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432616699",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Penny Peterson
• Zoey Taylor Petitt, MD
• Rachel A Petracca, APRN
• Erika L Petri, LCSW
• Natalie Margaret Petrone, OTD, OTR/L
• Julie Catherine Pettit-Lane, DPT
• Andrea Pettit, ATC
• Samuel Matthias Pettit, DO
• Christine Peura, LCPC-C
• George Peyser

• Pediatrics Physician in Portland, ME
• Providers in Portland, ME by specialty
• Pediatrics Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.